Already a member?

Health insurers should stop paying for painkiller abuse

The contents of the nation's medicine cabinets are likely
impacting the cost of your
health insurance
.

Back in 2007, the Coalition Against Insurance Fraud (CAIF), an
alliance of consumer groups, insurance companies and government
agencies, reported that misuse of prescription painkillers was
costing health insurers more than $72.5 billion a year.

That figure likely has become much higher, since the number of
people abusing opoids -- drugs intended to alleviate pain -- has
been steadily rising. The most commonly abused opioids are
oxycodone
, marketed under the brand name OxyContin, and
hydrocodone
, marketed as Vicodin.

Indeed, last year the Centers for Disease Control and Prevention
(CDC) issued a report in which it said the abuse of prescription
painkillers had
grown to "epidemic" proportions
.

Here's a chart on commonly abused prescription drugs from the
National Institute on Drug Abuse.

Statistics are alarming

"According to the CDC report, more people now die from misuse of
prescription painkillers than from cocaine and heroin combined,"
says James Quiggle, spokesperson for CAIF.

The problem affects people of all ages and from all economic
groups, Quiggle says.

Some people who become addicted to painkillers "doctor shop":
They visit different doctors to get multiple prescriptions for the
same drug. The average doctor shopper can cost insurance companies
$10,000 to $15,000 a year, Quiggle says.

"When someone becomes drug-dependent, his insurance company is
not only paying for his drugs, but also possibly for his
rehabilitation and medical treatment, which adds to the health care
costs that everyone helps pay," Quiggle says. Insurance companies
must pass along the costs of the drugs and treatment to other
customers as "part of their normal cost of doing business."

And those numbers don't include the cost of lost workplace
productivity or the costs to the criminal justice system, Quiggle
notes.

Burdening the health insurance system

Health insurance companies are aware of the problem and its
staggering cost to all consumers, says Susan Pisano, spokesperson
for America's Health Insurance Plans. "We strongly agree that
prescription drug abuse is a concern, not only in terms of the
extra burden on health care but most importantly in terms of
patient safety," she says.

Still, painkiller abuse poses a dilemma for health plans.
Insurers aren't able to refuse to pay for valid prescriptions that
are covered under a policy.

Mary Ann Schultz, spokesperson for Blue Cross and Blue Shield of
Illinois, says that if a patient has a prescription from his or her
doctor and has drug or pharmacy benefits, the prescription has to
be processed. "All medical decisions remain between the physician
and patient," she says.

However, Pisano and Quiggle say there are steps that health
insurers can take to monitor abuse and help curb it.

They include:

Educating providers.
"Some make provider education, in terms of the appropriate use of
painkillers and those drugs that are more likely to be addicting,
a priority," Pisano says. Doctors are encouraged to only
prescribe painkillers when they're certain they are
necessary.

Requiring step therapy.
Nicole Evans, spokesperson for the California Association of
Health Plans, says many health plans require doctors to start
patients on the lowest level of the painkiller that is least
likely to be addictive and "to move the patients up only when
necessary."

Limiting the duration of a prescription.
Some prescriptions are not considered valid after six months and
can't be renewed without a doctor's re-evaluation.

Monitoring usage.
Some insurance claims departments and pharmacy benefit managers
have data-mining programs to alert them when patients are filling
a large number of prescriptions for painkillers or appear to be
doctor shopping. "They need to identify patterns of potential
abuse, so they can be caught as early as possible," Quiggle
says.

More needs to be done

Quiggle says there needs to be more information sharing among
insurance companies. Fraud and abuse can be the result of auto
insurance, health insurance and worker's compensation insurance all
paying for the same painkillers, he explains.

"If insurance companies would systematically share data, they
could uncover far more patterns and cases of drug abuse than they
are now and they might also discover large rings that are operating
that they don't currently see," Quiggle says.

Law and drug enforcement agencies also are addressing the issue,
Quiggle says. As of last year, almost every state had adopted or
authorized prescription drug monitoring programs that track the
distribution of prescription drugs and alert law enforcement
officials to potential abuse.

The views and opinions expressed herein are the views and opinions of the author and do not necessarily reflect those of The NASDAQ OMX Group, Inc.

Please note that once you make your selection, it will apply to all future visits to NASDAQ.com.
If, at any time, you are interested in reverting to our default settings, please select Default Setting above.

If you have any questions or encounter any issues in changing your default settings, please email isfeedback@nasdaq.com.

Please confirm your selection:

You have selected to change your default setting for the Quote Search. This will now be your default target page;
unless you change your configuration again, or you delete your
cookies. Are you sure you want to change your settings?